Healthcare Provider Details

I. General information

NPI: 1033996236
Provider Name (Legal Business Name): TRANSFORMATION MENTAL HEALTH THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 N IRONWOOD PKWY STE 120
COEUR D ALENE ID
83814-2647
US

IV. Provider business mailing address

2005 N IRONWOOD PKWY STE 120
COEUR D ALENE ID
83814-2647
US

V. Phone/Fax

Practice location:
  • Phone: 208-704-0342
  • Fax:
Mailing address:
  • Phone: 208-704-0342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY LYNN SHELDEN
Title or Position: OWNER/THERAPIST
Credential: LCSW
Phone: 208-704-0342